Our Issues

Policy priorities for the Association are determined by a number of governing committees that advise the TAHC&H Board of Directors.Our policy committees include Pediatrics, Private Pay, Community Care Services, Medicare/Medicaid, Hospice, and Government Affairs.These committees meet four times per year in person and additionally on an ad hoc basis to discuss current issues affecting the industry and make decisions on how to direct Association staff time and resources. This process is used to establish our state and federal home health and federal hospice legislative priorities.

TAHC&H engages in the public policy debate before, during and after an idea becomes reality.We address issues affecting home care and hospice at the state and federal levels from the moment an idea is proposed, to its introduction as legislation, to the implementation stages.Here are some of our current issues.

State Issues

Community First Choice (CFC) was initiated by the Centers for Medicare and Medicaid Services (CMS).The rule gave states the option of drawing down a 6% additional match in federal funds to expand access to home and community based services. In late 2015 the Texas Health and Human Services Commission (HHSC) amended its State Plan to offer home and community based services to all individuals that qualify, or have an "institutional level-of-care" need. Personal attendant services and habilitation will be available to any individual who qualifies in the 1915(c) waivers or in the STAR+Plus Medicaid Managed Care model.

HB 4001 - In 2015 TAHC&H passed legislation (HB 4001) adding a definition of "habilitation" to the Home and Community Supports Services (HCSS) license.Many home care agencies had traditionally provided this service through waiver programs.This clarification will add assurances to managed care organizations that HCSSAs can and do provide habilitation services.

Electronic Visit Verification (EVV) is a system for verifying the time-in and time-out of direct service workers.Passed by the legislature in SB 7, 82nd Texas Legislature, HHSC rolled-out EVV to select parts of the state between 2011 and 2013.EVV was expanded state-wide beginning in 2014.TAHC&H members experience ongoing implementation challenges with these systems and the association continues to work through these problems with the state.

Dual-eligible Demonstration - Also known as the federal Financial Alignment Initiative (FAI), the dual eligible demonstration being rolled-out in Texas and throughout the nation seeks to improve care coordination for individuals who are covered by both Medicaid and Medicare.

STAR Kids is a new Medicaid managed care program that will provide Medicaid benefits to individuals with disabilities under the age of 21. Beginning Fall 2016, children and youth age 20 or younger who either receive Supplemental Security Income (SSI) Medicaid or are enrolled in the Medically Dependent Children Program (MDCP) will receive all of their services through a STAR Kids health plan. Children and youth who receive services through other 1915(c) waiver programs will receive their basic health services (acute care) through STAR Kids.

STAR+Plus is a Texas Medicaid managed care program for people who have disabilities or are age 65 or older. People in STAR+PLUS get Medicaid health-care and long-term services and support through a medical plan that they choose.Many home care agencies provide services to people with a STAR+Plus plan.The new era of managed care has meant significant challenges for home care agencies who are moving from a fee-for-service model to an insurance model of payment.TAHC&H advocates for policies that support access to care, adequate networks of providers, and smooth administrative procedures for contracted health care providers.

Pediatric Therapy - During the 84th Texas Legislative Session (2015), the Senate included language in the final budget bill that would drastically reduce reimbursement for pediatric therapy providers.The final budget bill cuts $350 million in funding to speech, occupational, and physical therapies to children with disabilities.TAHC&H estimates that this could affect access to care for nearly 60,000 children in Texas.The rate reductions to Medicaid therapy went into effect December 15, 2016.TAHC&H continues to work with legislators and HHSC to find a path forward that protects critical access to services for children with disabilities.

Medicaid Re-enrollment - All health care providers that contract with Texas Medicaid must re-enroll in the program, as per the Patient Protection and Affordable Care Act (ACA). TAHC&H has been working hard with the commission and TMHP to address the many issues that providers have experienced with the enrollment process and had been pressing the state to request a delay from CMS.The new re-enrollment deadline is Sept. 25, 2016.

Network Adequacy in Managed Care - TAHC&H worked with its partners to pass SB 760, 84th Texas Legislature, to improve access to care in Medicaid managed care.Medicaid beneficiaries have been experiencing significant delays in accessing care or finding specialty providers to meet their needs.SB 760 will go a long way to improving provider networks in managed care insurance. The association continues to work with HHSC on implementation of the bill.

Home Telemonitoring - In 2013 Texas was one of the first states in the nation to pass legislation permitting Medicaid providers to be reimbursed for home telemonitoring technology.Home telemonitoring technology allows health care providers to check a patient's vital signs remotely and respond if there is a patient health and safety event requiring intervention.

Federal Issues

Face-to-face- Centers for Medicaid & Medicare Services
(CMS) issued a rule that requires an in-person consultation between a physician
and a patient no more than 90 days before the first home health services or no
later than 30 days after admission to home health. CMS imposed burdensome, duplicative, costly
and confusing documentation requirements that exceed the intent of the law
passed by Congress. The increased paperwork burden has created a disincentive
for physicians to recommend home health care. Congress should enact legislation
repealing or reforming this rule.

Pre-Claim Review - Centers for Medicaid & Medicare Services (CMS) has proposed a demonstration program for Medicare home health pre-claim review in 5 designated states: Florida, Texas, Illinois, Michigan, and Massachusetts. The proposal as described would implement a demonstration project to develop and test a Medicare pre-claim or prior authorization process for identifying and preventing fraud before home health claims could be submitted and processed. While the industry recognizes the need for intelligent policies to combat fraud, waste, and abuse – we are against policies that simply do not work and harm patients.There is a bill in Congress, the Pre-Claim Undermines Seniors' Health (PUSH) Act, that would impose a one year moratorium on the Pre-Claim Review Demonstration (PCR) and requires CMS to report to Congress on the impact of the project on patients, home health agencies, physicians, and Medicare spending.

HHPPS Rebasing - Under the CMS rate rebasing rule, CMS
concedes that at least 43% percent of home health agencies will be paid less
than their costs by 2017.Congress
should a) postpone implementation and require CMS to reevaluate the rule to
consider all usual and customary business costs, consistent with standards
under the Internal Revenue Code, telehealth services, all disciplines of
caregivers, and usual business operating expenses along with needs for
operating capital and operating margins; b) establish transparent and accurate
processes for modification of PPS payment rates and case-mix adjustments; and
c) ensure full market basket updates to Medicare home health payments.

Department of Labor Repeal of the Companionship Exemption -
In 2011 the Department of Labor issued guidance that reinterpreted and
effectively repealed Congress’ 1974 “companionship exemption” within the Fair
Labor Standards Act (FLSA).For the past
nearly 40 years, the exemption has meant that direct-care workers who met
certain criteria did not have to be subject to the same minimum wage and
overtime in the FLSA as other workers. A lawsuit contesting the DOL rule, led
by the national home care association and others, is pending in federal court.

Medicare Program Integrity - CMS contracts with for-profit
companies called RACs to audit and recoup improper payments from Medicare
providers; and ZPICs to prevent, detect and deter Medicare fraud. CMS and
Congress must undertake comprehensive reform of the audit processes to make it
more accurate, fair and transparent.RACs and ZPICs frequently utilize questionable tactics, faulty data, and
sloppy processes resulting in a staggering number of recoupments and provider
appeals to the HHS Office of Medicare Hearings and Appeals (OMHA).Inappropriate payment denials leave home
health agencies with no other option but to appeal in order to receive payment
for medically necessary services they delivered to Medicare beneficiaries.

Accountable Care Organizations (ACOs) are groups of doctors,
hospitals, and other health care providers, who come together voluntarily to
give coordinated high quality care to their Medicare patients.TAHC&H works to educate home care
agencies on how to effectively participate in ACOs and does select outreach to
these organizations to promote the use of health care at home.

Comprehensive Care for Joint Replacement Payment Model -
This model tests bundled payment and quality measurement for an episode of care
associated with hip and knee replacements to encourage hospitals, physicians,
and post-acute care providers to work together to improve the quality and
coordination of care from the initial hospitalization through recovery.
TAHC&H submitted detailed comments and is working with our members and CMS
to ensure success for home care providers in this model.

Value Based Purchasing - As Congress considers legislation
to introduce Value Based Purchasing (VBP) in Medicare, lawmakers should work
closely with industry leaders to ensure that these payment reforms support
patient-centered care, access to home care services and utilize an “at-risk”
payment share that is commensurate with other health care industries (e.g. no
greater than 2%).VBP should base
at-risk payments on a small number of true clinical quality measures that
indicate patient health outcomes.